Andrick Schall - healthcare musings from the frontlines
"Everyone you meet is fighting a battle you know nothing about. Be kind. Always."
Hey everybody, while I’m on hiatus from writing, anybody in the Seattle area who who works in healthcare is welcome to join my group on Facebook: Seattle Healthcare Workers.
https://www.facebook.com/groups/254906516165547
So, if you’re in Seattle, in healthcare, and want to talk shop, check it out!
Thanks everybody!
Andrick
Hey everybody!
As I mentioned in my last post, my blog is going on hiatus for a while. I love writing, but there are other things that I would like to tend to.
The blog will remain up, and, no doubt, I will probably write something new in the near future!
If anyone would like to write a guest post, please let me know. And, as always, feel free to reach out to me via ‘contact me.’
I’ll be back! Thank you to all who enjoyed the writing, for the likes, and for the shares!
There are two links to this site: andrickschall.com – and – themanicbiomechnic.com – I will be retiring the manicbiomechanic domain name soon, but for a little while either link should work. Fairly soon, it will just be: andrickschall.com
Thank you everyone!
I’m clocking out for lunch….
BROWN EYES – 1997
I first met in her in mid-May, both of us in a strange place in a strange state of mind. Neither of us could adequately explain what brought us to that place, but her company there in that isolated pocket of sadness was an unexpected source of happiness, of companionship, and, eventually, guilt. But for those two weeks, she was my rock, my angel, and above all, someone who understood.
She had the most beautiful brown eyes. In fact, that’s what I called her: ‘Brown Eyes.’ Peering into them was as if I were at the edge of deep pool of still, dark waters, both calming and dangerous at the same time. There were several of us there, about twenty, but Brown Eyes was the only one close to my age; myself, 23, Brown Eyes, 22. We hung close to each other those two weeks. Practically every hour of the day.
Soon, however, we understood that it was pain, a deep hurting, that brought us to that place. Sometimes, a mind will work against its own, the cause of which could be a host of things, and will damage that soul, driving them down, causing pain, causing despair, madness, and, all too often, death.
Brown Eyes was an incredibly gorgeous young woman, both to the eyes and to the mind. She was caring, compassionate, prone to giggling, and a devoted listener. She radiated a warmth that I was instantly drawn to, a solace in a world gone mad.
Yes, we stuck together. We loved each other’s company, yet we were both afraid, both hurting. No wonder, then, that we were drawn to each other. But though our time together was brief, the days we spent together were full of closeness, friendship, and a kinship that I will never forget. Brown eyes and I used to have wonderful times together. We played poker, told hilarious stories about ourselves while we smoked cigarettes on the patio, we watched (and mocked) the nightly film, we ate together, and sometimes we were just together. We were as close as two young people could be in a place such as there. We shared a bond. We shared everything.
I remember once, one of the older residents, at one of our sessions, noticed the spark between Brown Eyes and myself. She remarked: “You two are going to get together when you get out here, aren’t you?”
We both blushed. Brown Eyes managed a: “Well….” I smiled broadly, in the hopeful affirmative.
But Brown Eyes was hurting. Deeply. I so wanted her to get better, to see that she had value, to myself and to the world. Once, when we were journaling together, she had written ‘I am hopeless’ repeatedly across her worksheet. That crushed me. No one is hopeless. All life is precious.
I never discovered what brought her to that place, but her pain, so evident when it manifested, was so profound, so powerful, I could not help but be wounded further myself. I would find herself alone, trying to sleep, but crying. The suffering Brown Eyes would be curled up into a ball, clutching a Roald Dahl book, no doubt a book from her childhood, from a happier time. I went to her then, and felt her pain, stronger than my own. I did not understand it wholly, but I knew what it was like. I would hold her. Our little world, however, was constantly monitored. Such is the nature, the precautions the physicians must take, when two young people find themselves in the psychiatric unit of an old hospital on Seattle’s First Hill.
I remember what brought me there. I had been diagnosed with clinical depression only a year before. The treatment was still new to me, and I was battling old demons at the same time. Note to self: certain medications and alcohol are a terrible mix. My physician saw the signs as I collapsed, the ideations. Thus, this was how I met Brown Eyes.
Her eyes. Those deep worlds of both pain and compassion; never will I forget them. I remember the day Brown Eyes was discharged. She had given me her phone number. I will always remember this moment, the last time Brown Eyes spoke to me: “Please,” she said, “Do call.” I promised I would.
I don’t know why, but I waited a day. Perhaps I wanted to give her time to reacclimate with her family. Perhaps I thought it too early, for whatever reason. This is a regret that haunted me, ate at me, damaged me for several years.
I eventually did call her, the next morning after breakfast. The phone just continued to ring. I called several times that day, but no answer, no machine. The phone would just continue its incessant ringing. Finally, that evening, someone picked up. “May I talk to Brown Eyes, please,” I asked. The voice replied: “Who’s calling?” There was a sense of disbelief, and also inconvenience in his voice. “This is Andrick,” I replied, “A friend of hers from the hospital.” There was a long pause, followed by deep sigh. Finally, the voice, an uncle, spoke: “Brown Eyes is dead.”
My world collapsed. My time in the hospital was extended. I recall very little of the first few days afterwards. And yet, even in those dark days, I strongly disagreed with Brown Eyes: There is always hope. With the skill of the mental health providers at the hospital, and the daily visits from my psychiatrist, I improved. I wanted to improve. My father, whom I recently lost, would visit me everyday. Friends would call me, offering support. This is crucial to a recovery from a mental illness: a strong social support system and a team of dedicated professionals. And recover I did, more determined than ever to live. This was the first gift that Brown Eyes left me with: the will to push on, to live, to change the lens and see the world, and myself, as a wonderful place to be. This was her second gift to me: suicide will destroy those left behind.
RECOVERY
I was not in the hospital much longer. Though I had learned painful lessons, this is often how one learns and grows, especially in the assessment of those lessons. Pain is there to teach.
My psychiatrist was very skilled. He was both a physician of the brain, and a psychologist of human behavior. My Doctor was a rare breed then, and now, practically, an anachronism.
I have written on this before:
Now, these days, an unfortunate schism has happened: the divorce of psychiatry and psychology. But in 1997, I was very fortunate to have my physician and my confidant in the same office. Our visits were for an hour, several days a week after my discharge, as I began the healing process. We would discuss medication, but we would also discuss the illness, and the guilt.
Though I had only known Brown Eyes for two weeks, the bond we shared, in that environment, with someone my age who suffered a similar illness, was strong. My Doctor and I spoke of her extensively, and the choice she had made.
For that is what her suicide was: her choice. But the nagging guilt still gnawed at me; why didn’t I call sooner? What if I had said something different in our time together? What could I have done?
My recovery was strong. I returned to acting. The local theater community in Seattle was a strong source of support. I loved to perform for an audience, an emotional release you might not be able to tap offstage. I worked in hospitality, and rose to the position of Operations Manager. I switched to banking, where I eventually filled the same roll, with Chase Bank for fifteen years. I tried my hand at writing, and had a couple of books published (they were not very good, nor well received…. it turns out I am better at writing essays than I am at writing novels). At the tender age of 47, I made another choice, one of the best I have ever made. And so now I find myself in healthcare. Ironic, perhaps, but a profession I love nonetheless.
But those early years after the hospital were a steep climb. And yet, recover I did. Those who have recovered from a mental illness are aware that this is an affliction that may forever be a part of them. But, along the way, you learn skills, and ways to cope, so that each time the affliction attempts to return, you know what to do. Oftentimes, this involves one the hardest things there is to do: ask for help.
But there was always that little demon in the back of my mind, worming its way into my consciousness: that feeling of guilt. Eventually, as part of the healing process, you must accept that certain things are not your fault. There was nothing I could have done. Brown Eyes had made her decision. I understood her pain; I understand why she did it. Sometimes, the dark night of the soul is so powerful, one sees the only relief as oblivion. It was a decision I myself could never make. This was her choice. It was not my fault.
SUICIDE IN AMERICA
Suicide is the most destructive act one can do to those that love them. Survivors of those who have lost loved ones are often adrift emotionally and mentally, sometimes for years, or for the rest of their lives.
It is a difficult subject to broach, as it always stirs feelings of confusion, sadness, resentment, depression. Those who have lost loved ones to suicide oftentimes find themselves alone and misunderstood. Conversations can be awkward. The guilt can be overpowering.
Survivor’s guilt can lead to complicated grief, a kind of post-traumatic stress disorder than can degenerate into depression. Most of us have faced death, and we feel the hole it leaves within us. But to lose a loved one to suicide is a wound that is very difficult to heal.
Yet talk about suicide we must. Here in America, though we have faced profound problems for the last year and a half (to put it rather lightly), we have the resources and intelligence to address this problem. And a problem it is:
https://afsp.org/suicide-statistics/
In 2020, over 48,000 Americans died by suicide, making it the 10th leading cause of death in the country. On average, 132 Americans died by suicide every day.
Suicide is to succumb to the darkness, but it is also a desperate cry for help: a staggering 1.4 million Americans attempted suicide.
Suicide is the 4th leading cause of death of those aged 35-54.
A statistic that is absolutely heartbreaking: suicide is the 2nd leading cause of death of those between the ages of 10 and 34.
Every day, 22 American military veterans take their own lives. That is 1 suicide every 65 minutes. This number is appalling and unacceptable. No matter what your stripes, these men and women put their lives on the line every day, for very little money and insufficient appreciation.
THE LACK OF MENTAL HEALTH RESOURCES
Though suicide is obviously a profound problem in the United States, there is an unfortunate lack of resources for the mentally ill. At every clinic I’ve worked at, nearly every provider has decried the lack of options and availability for those who are on the edge. But, these physicians do their best. If one is depressed, and contemplating suicide, it is better to seek help from any Doctor than none at all. Every Doctor you will meet, every Nurse, every Medical Assistant; all of them will do their absolute best they can for you. I have worked among some of the best. They are dedicated to their craft, and to helping you heal as best as they possibly can.
Though we have come a very long way in understanding and accepting the existence of mental illness, we still have quite a ways to go. The social stigma still exists. The lack of awareness, though decreasing, is still present. There are often limited options and long waits to see a mental health professional. And, though I realize this is a subject of debate, healthcare in America can be egregiously expensive, and oftentimes, recovering from a mental illness takes in-depth and lengthy care.
WHAT YOU CAN DO
First and foremost, if you are having thoughts of suicide, and have made plans: CALL 911.
If you are depressed, or feel that life is not worth living: reach out for help. See a Doctor. See your religious counselor. Talk to a friend or family member you can trust.
If you are a survivor of losing someone to suicide, take care of yourself. It will take time to heal. As so above: reach out for help, wherever you can find it. Someone out there knows what you are going through. You are not alone.
In fact: Anyone suffering from depression or thinking of hurting themselves; please realize, you have value, you have a future, and you are not alone.
National Suicide Prevention Lifeline: 800-273-8255
Veterans Help Line, for those currently serving: 800-342-9647
Disaster Distress Helpline: 1-800-985-5990
https://afsp.org/ (American Foundation for Suicide Prevention)
https://www.nimh.nih.gov/health/topics/suicide-prevention/ (National Institute of Mental Health)
https://www.mentalhealth.va.gov/suicide_prevention/data.asp (for veterans)
https://www.militaryveteranproject.org/22aday-movement.html (for veterans)
https://youth.gov/youth-topics/youth-suicide-prevention (for teens and young adults)
As the saying goes: I would rather listen to your story than attend your funeral.
PROJECT SEMICOLON
Project Semicolon, stylized as ‘Project;’ is an American nonprofit organization known for its advocacy of mental health wellness and its focus as an anti-suicide initiative. It was founded in 2013 by Amy Bleuel of Wisconsin, who lost her father to suicide in 2003. Tragically, Bleuel herself committed suicide in 2017.
Project Semicolon defines itself as “dedicated to presenting hope and love for those who are struggling with mental illness, suicide, addiction and self-injury”, and “exists to encourage, love, and inspire.” A semicolon ( ; ) is used as a metaphor: the author could have ended the sentence, but chose not to. “The author is you and the sentence is your life.”
Today, one might see or notice people with the semicolon tattoo. Many celebrities have been seen with such a tattoo. I dislike it when entertainers use their positions of prominence to talk about politics, but if they are bringing awareness to mental illness, more power to them.
IGY6
IGY6, or: I’ve got your six (I’ve got your back) was inspired by project semicolon, created by military combat veterans to advocate for suicide prevention and awareness. One may occasionally see a veteran or first responder emblazoned with “IGY6;22.” The number 22 represents the number of combat veterans who commit suicide every day.
BROWN EYES, 2021
It was not until earlier this year that I accomplished something that I had neglected to do, perhaps unconsciously. I have lead an exciting and successful life; setbacks, here and there, to be sure, but with my new education and my new love of healthcare, I have a great future to look forward to, full of potential. But it occurred to me, 24 years later, that I never officially said goodbye.
It took a little digging on the internet, but I found it. I drove across town, and visited Brown Eyes’ grave.
There was an outpouring of emotion, to be sure, as memories came back. But there was also a sense of relief, of closure that I was not aware I needed. Her grave is on a beautiful, gentle hill, overlooking Seattle. It sits underneath a Japanese Holly tree, surrounded by trinkets and memories of those who had come by.
I said goodbye to Brown Eyes. I said I loved her, that I was not angry with her, and that it was her choice, but I wish she had made a different one. I imagined the conversation we might have had then, had she survived her illness, so long ago, as if we were two old friends, catching up on old times. I have absolutely no idea what happens in the world to come, but if we persist, in whatever form, after death, she will be the first person I hug.
Good bye, Brown Eyes! I remember your spirit, and our memories, both of which I will carry; your story is not over.
Dedicated to Hannah Elaine Harvey, 1974 – 1997
HIATUS
This will be my last blog post for the foreseeable future. Though I have loved writing my observations and thoughts on healthcare, it is time-consuming, and there are things I must move on to. All of you who enjoyed reading my posts, I can’t thank you enough. My website will still be there, and, somewhere down the road, I may post again. Thank you all, and do feel free to contact me.
Thank you all! Wash your hands! Get vaccinated! Take care of yourselves! Take care of each other! Bye for now….
Okay! I have a guest post today. It’s my brother Pedro (his name is Peter, I call him Pedro), and I asked him to share his experiences with a seriously bad roll of the medical dice. When he was about 11, in the 6th grade, he came down with a disease known as mononucleosis. He recovered, but six months later, he came down with another nasty disease known as meningitis. Dang! That’s some bad luck, big brother! So, he was kind enough to share his experiences of the ordeal(s). He was young, so many of his memories are hazy, but he clearly recalls the more painful moments during this time span of infections. Myself, I would have been about 6, so all I remember is that my big brother was home from school, not feeling well, and we had to have separate eating and drinking utensils for him. Then I probably played with my legos.
Both mononucleosis and meningitis are serious and potentially deadly diseases. During his narrative, I will jump in and do my best to explain what he may have been experiencing. Take it away, Pedro!
I left school one day, feeling kind of weak. By the time I got off the school bus, the weakness and fatigue had increased. I went to school the next day, but the teacher sent me to the nurses office, as it was obvious to her that I was feeling tired. I had also complained of a headache. By the time I got to the nurse’s office, I ended up barfing on her desk. Mom had to come pick me up.
It is widely known that younger adults, and specifically children, are more susceptible to disease. This is simply because their immune system has not been around long enough to develop antibodies to the various pathogens that love to call human beings home. Their defense mechanism is simply not yet developed, like the rest of their bodies. Most young children have 6 to 8 colds per year, according to John Hopkins Medicine.
Mom and Dad thought it might just be a cold or a flu, but I began to gradually feel weaker, I had a fever, no energy, and I had trouble keeping food down. I had a pretty bad sore throat. The weakness is what I remember the most. After a few days, Mom and Dad took me to the Doctor. My lymph nodes had begun to swell and actually felt like little rocks. I barfed in the Doctor’s office. Mom says I cried when they drew blood from me, but you ought to see my brother try and practice blood draws.
Shut up.
Later that day, the Doctor called to say that I had mononucleosis. I had no idea what that meant. Mom and Dad tried their best to explain it to me, but to me, it just felt like a really awful flu.
Unlike most diseases that infect children, mononucleosis typically effects young children in the early and mid puberty stages of life. Adults can definitely be infected with mononucleosis, but in those instances, the symptoms are usually mild to moderate. There is no vaccine against mononucleosis.
Yeah, like a bad flu. But it just wouldn’t go away. I started to feel better, but only gradually. I was out of school for almost two weeks. At the beginning of the second week, I started to feel a little better. My lymph nodes had returned to their normal state, I was no longer nauseaus, and my fever lowered back to an almost normal temperature. But I was seriously fatigued.
There is no specific treatment for mononucleosis. Like a flu, bedrest, OTC painkillers and a simple diet will do the trick. The disease itself is usually caused by the Epstein-Barr virus, one of the eleven or so types of herpes that can infect human beings (hey… it doesn’t have to be sex… my brother was 11…) In fact, about 90% of the world’s population is infected with the Epstein-Barr virus at some point in their lives, usually with no ill effects.
https://www.sciencedaily.com/releases/2010/12/101215121905.htm
The little virus is generally spread by contact with an infected person’s saliva, hence, it is often called the ‘kissing disease.’ My mother recalls the kids our age that lived in the house being sick just before my brother came down with mono, and if they were playing around, and shared a swig of soda pop, that might have done it. However, we all have to eat and drink, and we typically use utensils to do so, so Pedro could have caught it just about anywhere.
The virus usually attacks the epithelial (goop, mucous) that lines your alimentary canal (the passageway from your mouth to your pooper) in the pharynx, often causing a sore throat. Later, the virus goes to war and tried to replicate your B-cells (a lymphocyte, one of your system’s bodyguards). In most cases, your B-cells win this round, and develop antibodies, a sort of ‘memory’ of how to defeat this antigen (a substance, a pathogen, anything nasty that invades your body).
Viruses like human hosts. Viruses exist. Viruses can be easily transmitted. Some viruses are particularly nasty, aggressive, unpredictable, and opportunistic. Some of these viruses can kill over 600,000 Americans, even though there are precautions you can take to avoid them. If there is a vaccine against this virus, it would probably be a very good idea to get it. I don’t know what made me think of that. But I digress…
In the few days before I was supposed to go to school, my teachers started sending me stuff I had missed. I don’t know how people found out, but when I first got back to school, my friends were avoiding me like the plague. It didn’t last long, though, they could tell I wasn’t sick anymore, and I had a bunch of missed class stuff to catch up on.
Mononucleosis is not a reportable disease in Washington State, despite it’s prevalence to easily spread. It rarely causes serious problems, and it goes away with time. That’s not to say it’s an easy ordeal; like my brother said, it’s like a bad flu, only it last about two weeks.
I felt fine for a long time after that, with no lasting effects. But then, about 6 months later, I woke up Sunday, after going skiing on Saturday, with a sudden fever of 102 degrees. I felt cruddy and tired, worse than the mono.
Again, children and young adults have weaker immune systems. It was postulated, later on by his physician, that my brother’s mononucleosis, though he had recovered from it, was still doing lingering damage to his immune system as it rebuilt itself. The pathology is not well understood, but it has been estimated, by one study, that 1-18% of children who are infected with mononucleosis are susceptible to meningitis:
https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-11-281
I was no better, in fact I was worse, Monday morning. My parents took me to Children’s Hospital. By that time, my fever had increased, my neck was terribly stiff, and I had trouble looking at bright lights. I had no idea what was going on.
Well, I’ve said it before. Seattle is a good place to get sick. Some of the best healthcare providers in the world are here. The sudden, rapid symptoms my brother was describing immediately cued the physician that this might be a case of meningitis. The definitive diagnostic to test for the presence of the disease is the performance of a lumbar puncture, better known as a spinal tap.
I remember laying on my right side. The doctor put anesthesia on my back, but it really didn’t do any good. Dad had to hold my legs down so that I wouldn’t buck and break the needle off in my spine. I really can’t describe the pain. Incredible pain. It was more like an electric shock. Thankfully, the needle was in my spine for only a few seconds.
A lumbar puncture is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. In my brother’s case, meningitis. I love the movie Spinal Tap, but after hearing my brother’s story, the medical procedure is not something I’d look forward to.
There are protective layers covering the brain and spinal cord known as meninges. There are actually three layers of meninges: dura mater, the arachnoid mater, and the pia mater. I’ll take anatomy for $600, LeVar. The word meninges comes from the Greek ‘membrane.’ Then: ‘itis’ is the medical term for inflammation. Hence: meningitis. This puts enormous pressure on the brain and spinal cord, causing severe pain for the victim. The entire human body’s entire nervous system stems from this area, and the entire body will be in pain.
There are a few different types of meningitis. The most common are bacterial and viral. Either one, particularly bacterial, left untreated, can cause septicemia: the poisoning of the blood, frequently fatal.
I remember when the doctor pulled the needle out. There was an odd little kind of wet ‘pop’ sound. As the doctor took the specimen to the lab, a nurse brought me an orange popscicle. They offered one to Mom and Dad, but they passed. I was still in incredible, intense pain. Evidently, the testing procedure did not take long, as the doctor returned before I had finished my popscicle.
The ‘good’ news was that my brother had viral meningitis, as opposed to bacterial. There are vaccines against this virus, and my parents were good about keeping us up to date, but sometimes the little creature will find a way. Viral meningitis will generally go away on it’s own. Some virus do not.
It’s most likely that my brother, with his immune system still rebuilding itself after mononucleosis, caught the virus while he was on his ski trip. On the bus, in the lodge, who knows. Viruses are opportunistic pathogens, and can spread very easily. It’s too bad that my brother was not wearing his ski MASK. And staying safe while speeding down the slopes, practicing proper SOCIAL DISTANCING. Because viruses are REAL and can easily spread if you don’t take PRECAUTIONS.
Hey! Is this my story, or your rant about Covid again?
Sorry. Go on.
When we got home, and I tried to sleep, I couldn’t. The pain was incredible. It felt like a third-degree burn all over my body. Cold beverages didn’t help. Aspirin didn’t help. I was in misery. The folks called the hospital, and the doctor told them that I’d pretty much have to ride it out. It sucked.
Had my brother had bacterial meningitis, there is a good chance he would not be here today, or, at the very least, be severely crippled. Children that are fortunate enough to survive bacterial meningitis face a lifetime of medical problems: memory loss, cognitive difficulties, difficulty retaining information, motor-skill and coordination problems, headaches, hearing impairment, epilepsy and seizures, paralysis and spasms, speech problems, potential blindness; all or none to varying degrees. I understand now why my mother could never watch the Jerry Lewis Telethons. To see a child suffer is the worst image possible.
Unlike the mono I had, this one didn’t last as long. I gradually felt better in about a week. But those first few days were fucking awful. It’s impossible to describe the pain. You cannot comprehend it until you have been through it.
So, back to school I went, and once again, I was way behind on schoolwork, and my classmates steered clear of me. But, eventually, life returned to normal.
Meningitis is a reportable disease, as it is contagious. How myself and my parents, and anyone else at my brother’s school, managed to not catch it as well is… just a roll of the medical dice.
Thanks Pedro!
Back in early 2020, when the world began to unravel, when I had just finished my first quarter of school, the lock-downs across the country had begun. My parents, I had both at the time, were considered vulnerable (right… remember when it only infected elderly people or people with compromised immune systems? It’ll go away in April! Like a miracle! Drink bleach!) and they were living in an assisted living facility. In fact, it’s only recently that restrictions have been relaxed, and I’ve been able to regularly visit my mother.
Anyway, I was having such a great time in school; I was particularity blown away by anatomy and physiology. The human body is an amazing machine. When our instructor first started lecturing about the roles that the cardiovascular and pulmonary systems play together, I devoured his words, scribbling furiously in my notebook. I read through the relevant chapters in our massive textbook. I was fascinated.
I wanted to tell my parents what I had learned, but that’s hard to do over the phone. So, I scribbled together these following pages and mailed my attempt to understand the human body off to them. They got a real kick out of it!
Needless to say, I was a green student, and I got plenty of things wrong in my notes. I think I got the actions of the diaphragm mixed up. I left out the other semilunar valve, the aortic valve. I did my best with the white blood cells, but I’m no biochemist. I got the test tube of blood wrong; white blood cells and platelets are actually in the middle, in a thin layer called the Buffy coat (seriously). There are also plenty of spelling and grammatical errors, and a few pages have this evening’s PB&J on them. Sorry about that.
If you manage to make it through my mangled scribbles of a new student barely understanding, and get to the part where I talk about platelets, you might notice something interesting. Platelets, the cells in your blood that form a mesh to stop bleeding, use serotonin in this process. This is the same serotonin that rattles around in your brain, affecting your mood, and are the primary target of most antidepressant medications. Huh. The human body’s kinda weird like that… Anyway, enjoy!
Thanks for reading! Wash your hands!
It is a well known fact that the healthcare industry does not speak English. Sure, when you’re talking to your doctor, or any practitioner, you’ll use layman’s terms, the ones we all know. Relatable, common sense terms. However, behind the scenes, healthcare has a needlessly complicated language. It’s like a strong tradition, a superstition almost. As if only the initiated can use this sacred tongue.
Typically, after any visit to a clinic or facility, you are given a sheet of paper, sometimes emailed, summarizing what your experience there was. It’s usually called an After Visit Summary, or a Visit Information Sheet. Depending on your facility, if you read the summary in-depth, you might see some of this obscure language pop up.
Much of the language of healthcare is derived from ancient Greek and Latin, when the smart people of the time began to (very slowly, often incorrectly) figure out how the human body works. The Latin work for uterus is ‘hyster,’ derived from hysteria, as the Greeks thought women could be overly emotional, as they did not understand that a woman ovulating can have her hormones thrown off. How charming of them. ‘Tomy’ means to cut, or remove. Thus: hysterectomy.
Today, much of the modern healthcare lexicon is an alphanumeric code, a relatively recent development. This eases communication between different languages, and it is also a common way for clinics to communicate with insurance companies.
Perhaps the most intriguing healthcare term of all is the eponym; that is, a procedure or discovery named after the person who pioneered it. The PAP smear was invented by Georgios Papanikolaou. The cruel disease of Alzheimer’s, an illness as old as humanity, was first pathologically described by Alois Alzheimer. Crohn’s disease was first identified by Burrill Crohn.
Now, considering anatomy, that is, the parts of the human body, there are many eponymous terms that, when first read, are downright silly. Here now, is a list of the most ridiculous sounding names for parts of your body:
Purkinje fibers: These are located near the bottom of the heart, and aid in the pumping action of the heart muscle and blood. They are named after Jan Evangelista Purkyně.
Bundle of His: (Actually pronounced bundle of HISS) These are fibers in your heart that help conduct the electrical impulse that keeps the heart beating. They were discovered by Wilhem His Jr.
Islets of Langerhans: These are parts of the pancreas that aid in the metabolism of glucose. They are named after researcher Paul Langerhans.
Cowper’s glands: These aid in the transmission of male semen from point A to point B. They are named after William Cowper. Mama Cowper must have been proud.
Pouch of Douglas: This is the pouch between the rectum and the uterus of the female body. Anatomist James Douglas took his work very seriously.
Golgi apparatus: This cellular substance aids in protein packaging. They are named for the Italian Scientist Camillo Golgi.
Loop of Henle: This handy little structure aids in the production of urine. It is named after German anatomist Freidrich Gustav Jakob Henle. Dr. Henle liked to study how we pee.
Little’s plexus: This is part of your nasal septum. It was first discovered by American surgeon James Little. I don’t know much about him, but judging by his name, he was probably 6’4″ and 280 lbs.
Crypts of Lushka: These are the mucous membranes on the inside of the gallbladder. They are named after German anatomist Dr. Hubert Von Luschka.
Zonule of Zinn: This is a suspensory ligament in the eye. They are named after Johann Gottfried Zinn.
Spiral valves of Heister These are valves in the cystic duct, connecting the gallbladder to the bile duct. They are named after German anatomist Lorenz Heister.
Wormian Bones: These are structural bones in the skull. They are named after Ole Worm, professor of anatomy at Copenhagen. Cool name.
Artemis Schlong: After centuries of debate, a name was finally settled on the name of the male reproductive organ in 1692, by Costa Rican anesthesiologist Artemis Schlong.
All human beings, gender dependent, have within them these anatomical parts with unusual and odd sounding names. There are of course, many more. And still… more to be discovered.
Wash your hands!
Healthcare is more than just needles and vitals. A long time ago, I remember my first day at the clinic. I was speaking with the front desk manager, and she asked me: “Do you have thick skin?”
I had just finished a 15 year stint at Chase Bank. I assumed she meant unruly and angry customers, only in this case, patients. I had indeed gotten used to angry customers at good old Chase. You can usually tell you might have a ticking time-bomb on your hands as soon as one of these types of customers hit the front door. I became very skilled at calming them down; it’s a trait I have carried over into healthcare. Patients can be nervous or angry. I’m good, most of the time, at alleviating some of these feelings.
I have come to realize she was talking about something else. Yes, you do have to be thick-skinned, as patients are not always in the best of moods when they come to a medical clinic. That’s why they’re at a medical clinic. I’m talking about a suit of armor you must wear, maintain, and strengthen.
It’s a suit of healthcare armor that every practitioner must wear. In fact, there are two layers to it. The first layer is the blood armor. The second layer, the harder one to develop, is the emotional armor.
It’s something that they can’t really teach you in school. In our first quarter, the instructor pulled no punches when he showed us images of what we might see. And the endless education about the tragic things that can go wrong with the human body; that gives you just a slight idea of what you might see. Healthcare is not for the squeamish.
To be honest, this has never been a problem for me, blood and guts. I don’t like seeing people suffering, but gore does not bother me. It’s disgusting and unfortunate that this has become a genre in the entertainment industry, torture porn. Eli Roth can go screw himself. But in reality, in my clinic, blood and gore occurs frequently. It’s never bothered me. I remember walking into an exam room after the provider I usually work with, Susan, texted me that she needed help with a punch biopsy. I walked into the room. Apparently, the area she was working with was more infected than expected. There was a large pool of blood on the floor. Huh, I said. Dr., you’ve got the patient’s DNA all over the floor. What can I help with?
My station is right next to the lab. More that once, I have had to run over and help our lab technician, a big, good-natured fellow who works in tight quarters, help a patient to the floor after they have passed out during a blood draw. He’s very skilled at helping people lie down in a cramped area, while I grab a pillow and a blood pressure cuff. And some apple juice. Afterwards, when the patient comes to, they are usually embarrassed. I’ve written about this before. We don’t judge you for that. Metal is going into your body, and you see your blood coming out. Perfectly natural, the fight or flight reflex.
We call this vasovagal syncope; fainting at the sight of blood. It’s actually somewhat common. People hate needles. I’ve written about this as well. Perfectly natural. You will never be shamed or judged by a healthcare worker. If you feel you are, advocate for yourself, and let the clinic know.
The stronger, more important armor to develop, the thick-skin the front desk manager was referring to on day one, is the emotional armor. It is imperative in healthcare that this armor be strong. But all of us realize that we are human beings. We have emotions, and you have to feel them. Like I said, I’m still a bit of a rookie, and my emotional armor is still developing. It gets stronger every day. Last week it became even stronger.
They cannot really teach you about this in school, either, even more so. But the fact is, if you are going to work in healthcare, your emotions will be tested.
The other day, Susan had a patient who was a recent stroke survivor. As in, very recently. His friend and neighbor, Gary, had found him unconscious on his apartment floor. This patient had spent a month in the hospital, and a month in rehabilitation. In fact, he had not been home yet. Gary, at the advice of the facility, which he had left just hours beforehand, had brought him straight to a doctor. This patient had no primary physician. This patient had no one really, just his friend Gary.
Of course, it reminded me of father. My father passed away last February, just two weeks shy of birthday number 93. He had had two strokes in the last two weeks. In a way, my father was lucky, though I still miss him greatly, every day. My father was surrounded by good medical care, his wife of over 60 years, and his family. He did not suffer long. He died peacefully, in his sleep, and stepped into whatever comes next.
But this patient had no one, except for his friend Gary. He had no next of kin; indeed, he had no close family. No other close friends. He was old, but getting along fine. Gary wheeled him into the exam room. During my rooming process, I asked Gary, as the patient was having difficulty speaking, how long he had used the wheelchair. Gary told me he was walking the day before the stroke. It was clear, as I took his vitals, that this patient had suffered badly.
After Susan had spent some time with him, we were wrapping up the visit, going over the next steps for him. Susan remarked how sad it was that this man was nearly alone, except for Gary. It had been a stressful day (not all of them are in healthcare, honestly), and I began to well up. Susan knew I had lost my father a few months ago. She apologized as I excused myself.
It was heartbreaking. To have this man go down so quickly, and so nearly alone. He had been walking two months ago. He did not have the care or the support my father had. It seemed cruel. Whatever your beliefs, God may be merciful, but Mother Nature is not.
I was cleaning up the exam room after the visit. Susan came in to talk to me, to see how I was doing. I tried to explain how sad that was, through a broken voice. Susan said that we are all human. She told me that I am still new, and that this is part of my education process. And she mentioned the cliché that happens to be very true: it never gets any easier. Your armor just gets stronger.
We’ve all seen interviews with the burned out nurses and MD’s, after working 4 or 5 days straight in the Covid ward. They are broken. Our armor is strong, but the hardships of life we encounter can be stronger. We are only human.
To a degree, you have to laugh about it, as a means of coping. We never mock a patient, but we do have to make each other laugh. I told Susan that if this were TV, we’d be sitting out on the loading dock, chain smoking, tears running down my face as Susan, with the thousand-yard stare, said: “I remember when I lost my first patient. It never gets any easier. Hang in there, rookie.” Of course, using her best Sam Elliot voice.
That’s my biggest challenge, going forward. Not a technical skill, not a memorization of what type of needle you use for what, but my emotional armor. I knew things like this would happen. You’re just never ready for it when you start.
The next day, Gary called us to let us know that the patient had died overnight, in his sleep.
Take care of yourselves!
There is a massive problem with the practice of psychiatry in today’s modern healthcare industry. There are several reasons for this, which I will address in a moment, but first, let’s get a few things out of the way.
Many people have a very reactionary, negative opinion of the field of psychiatry. They feel that it does more harm than good. In today’s healthcare environment, they may have a point, but I am speaking in general terms. Psychiatry, to many, is a dangerous science that can damage your brain. Of course; many medical procedures can damage you if administered improperly. That’s why I went to school. Many people feel that psychiatrists have very little clue as to what they are doing. While it is true that the study of the brain, which has remained a difficult and emerging science for a very long time, and will continue to be so, there are millions of Americans who have benefited from what psychiatry does know, and what treatments it can provide. And still others feel as though psychiatry, and indeed, any treatment of the mind or emotions, should be out of the realm of medicine, and kept in either the family or church. While it is very true, and studies have confirmed this, that those of faith, or at least some level of healthy optimism about life, tend to heal much quicker from whatever affliction they may have, that does not mean that medical intervention is sometimes required. Nor does it mean that atheists do not heal.
Plenty of people have a negative opinion of healthcare in general. That is unfortunate. Many millions of people have benefited from the proper treatment of an affliction, and go on to live healthy and productive lives, despite an illness that would have been a death sentence one hundred years ago. The human body is a machine, an amazing construction, the triumph of life on Earth (although the debate about that is for another time). Whether by evolution or design, you and I, and everyone else on Earth, are amazing creatures, composed of practically countless processes, organs, chemical and electrical reactions, and things still yet to be discovered. However, just like any other form of life, like any artificial machine, like any magnificent creation of geology, things can, quite simply put, break down. Sooner or later, it happens to all of us. Have you ever thrown your back out? Well, so have 65 million other Americans. We are wondrous creations, but not entirely perfect. Healthcare plays a role in our repair, and improving our quality of life.
But back to psychiatry. The negative connotations I mentioned above are not entirely unfounded. The history of psychiatry is replete with practices that today seem barbaric, and would never be considered as an option for treatment. What is worse, in modern history, authoritarian regimes have tortured and killed untold numbers under the guise of psychiatry: Nazi Germany, The Soviet Union; even the CIA is guilty of using psychiatry for nefarious purposes.
However, like all healthcare, psychiatry is an evolving field. Healthcare, in essence, is an applied science. That is, it is a scientific endeavor, used for practical means. Many constructive gains have been made. However, the application of these discoveries, when applied to the practice of modern American healthcare, has been severely misappropriated.
I can’t get into the tired debate of whether or not mental illness exists. Believe what you will. Many people, intelligent people, will claim that there is no definitive diagnostic test to prove whether or not a mental illness exists. It is true that nearly all mental illnesses, particularly the behavioral ones, are diagnosed by interview and observation, or that form you occasionally fill out at your annual exam where you check the corresponding box as to whether you are happy or sad. However, you can get out the fancy medical equipment and see it for yourself. In people with anxiety, a part of the brain called the amygdala is overactive. In cases of depression, insufficient monoamines are developed in the neurons of the brain. One could utilize these ludicrously expensive machines if you want to see the proof, but good luck getting insurance to pay for this.
Mental illness exists. I was once speaking to a friend of mine, who had a negative opinion of psychiatry, and said to just get that person with depression some dancing lessons, a cat, and an exercise program. Okay, Tom Cruise. You tell the guy with the gashes in his wrists who’s hanging from a noose to get some dancing lessons, B-vitamins, and some duct tape, and I’m sure he’ll be fine. Sheesh. But I needn’t be snide. Annually, roughly 49,000 Americans take their lives each year. Suicide is the 10th leading cause of death in the United States; however, it is the second leading cause of death for those between the ages of 15 to 34. There are, on average, 132 suicides per day. Perhaps worst of all, according to the Department of Veterans Affairs, 20 veterans die from suicide every day.
To be fair, engaging in activities that one enjoys that are healthy, socializing with others, becoming involved in a community art or political program; these are great ways to alleviate the symptoms of depression. So too with the natural remedies; regular exercise, a healthy lifestyle, artistic expression, prayer and faith, whatever you might like. But many people are too depressed to even get out of bed.
Besides depression, anxiety disorders are the most common psychiatric disorder in the United States. They affect 40 million people. Untreated, this illness will damage those around the afflicted, cost industry labor, and overburden the healthcare industry. People having panic attacks often end up in the emergency room. The number of those with anxiety disorders is no doubt growing, considering the trauma of the last year and a half.
And we’re not even talking about schizophrenia, ADHD, PTSD, bipolar disorder, panic disorder, and a host of others. Intelligent people with fancy degrees will argue that the DSM, the Diagnostic and Statistic Manual of Mental Disorders, is cluttered with debatable mental disorders. It contains nearly 300 diagnostic entries. It should be noted that the ICD, the International Classification of Diseases, contains about 80,000 entries.
But I am severely digressing. The main point I am getting at with this article is the unfortunate practice of psychiatry that one will often encounter when they visit their regular clinic or provider.
Somewhere along the way, a great disservice was done to the field of mental health. Psychiatry and psychology were divorced. This is profoundly wrong, and does not do nearly enough to heal the mentally and emotionally afflicted.
These two sciences, psychiatry and behavioral psychology, go hand in hand. They are deeply intertwined. You cannot simply address psychiatric needs while at the same time giving little consideration, or even downright ignoring, the psychology that goes along with psychiatric suffering. It is analogous to a physician simply giving a person with diabetes insulin, and telling them to monitor their blood sugar at home, while not counseling them on their dietary habits. So with psychiatry. You cannot simply throw pills at them, without addressing the psychology, usually damaged, that accompanies it. This makes no sense.
Unfortunately, that is the solution of much of modern healthcare: throw a pill at it. Also, due to the profit motive, patients are generally allotted 15 to 20 minutes for a visit with a healthcare provider. That is not enough time. The psychiatrist, or MD with a specialty in psychiatry, may ask them how they’re feeling, how’s the job, etc, but that is insufficient time to dig deep enough to treat the illness.
Psychotherapists exist, of course. However, they are harder to find, as insurance will still balk at their treatment, or they are booked far in advance due to the dire need, owing to the stressful times we live in.
Some clinics will not even have a dedicated psychiatrist. Your primary care physician will treat you. I’m sure that person cares about their patients, and has studied, at whatever length, both psychiatry and psychology, but they are much more likely to just throw pills at you, tell you to keep a journal or do some art or something, and come back and see them in a month.
I was diagnosed with a mental illness in my early 20’s. It should be noted that there is no ‘cure’ per se, but there are treatments to alleviate the symptoms, mental exercises to retrain your thinking, so to go on and live a healthy and happy life. I was able to do so. Despite a crippling depression, in a way, I was very fortunate. I was first treated by a seasoned psychiatrist, whom I called Dr. Dispensapill, who knew that psychiatry and psychology cannot be separated. He would see me for an hour. We would talk briefly about medications. Then we spend the bulk of the visit speaking about psychological challenges I might be facing. Then we would wrap it up with any medication or lifestyle changes to consider.
His is a disappearing style. You can still find psychiatrists like him, but they are rarely covered by insurance, and they are frequently booked far out.
Dr. Dispensapill, north of 80 years old, recently ceased being able to practice. It was difficult to find help for my mental health afterwards, but I have found a combination that works. I see, for 15 minutes at a time every few weeks, Dr. Deer In The Headlights, who knows little of psychotherapy, it seems, but knows all about the different medications and how they work. She got a 4.0 in advanced chemistry, I guess. I have also been able to find a very skilled psychotherapist, Dr. How Many PhD’s Does One Actually Need. She has been fantastic.
More than one of the providers that I work with have complained to their superiors that there is a woefully insufficient staff of human resources to refer psychiatric and deeply troubled psychological patients to. They will help the best they can, but they are there to treat skin rashes and broken bones.
This is a great problem in American healthcare. We have made a damaging mistake. The mentally ill are not getting the proper treatment that they so often need. The separation of psychiatry and psychology is, in my low-level practitioner opinion, the biggest systemic mistake modern American healthcare has made. You can’t treat one without treating the other, and vice versa.
Until we fix this problem, and there are other, massive problems with American healthcare, the treatment of the mentally ill will remain insufficient. Many more will take their lives. Millions will continue to be crippled with anxiety, living tortuous lives. And the dangerously mentally ill, with no options for treatment, will continue to commit violence.
I’m not sure why this happened. It shouldn’t have. Just my opinion.
Be good to each other.
National suicide hot-line: 800-273-8255
In early 2020, when I walked into class for the first time to train as a Medical Assistant, an obvious truth was right in front of me, so evident; but I did not notice. I had been painfully preoccupied with all the preparations required for going back to school. When you are doing it on your own at age 47, trying to also balance a life and another job, it takes all your time: the paperwork, the vaccinations you need, the textbooks you must purchase (at a very reasonable price….), the equipment you need, where you have to go, that sort of thing. But I had squared all these things away. I was ready to learn.
I was admittedly overwhelmed by my surprising mid-life crisis to enter healthcare. I had read through the aforementioned, completely reasonably priced textbook before class started. It was over 1000 pages, and that little voice in the back of my head, the one that still nags at me when I go to work, though much quieter now, was at full volume: What the hell are you doing! But on January 7th, 2020, into class I went.
I am a shy person by nature, and was still overwhelmed and nervous, so I saw a few of my classmates (we were a class of nine to begin with, and a few of us were already there), nodded my head, tried to smile, and took a seat.
The first few days were chaotic. Our program was a hybrid learning system, with in class lectures and clinical training, and at-home, online training modules. My opinion of the online training modules is still not settled. The jury is still out. More on that later. But we all had to learn how to log into the school’s system, we all had to make sure we had all the right equipment and uniforms (I had the wrong color scrubs… more on my instructor in a moment), and all of us, including myself, had endless questions. My instructor patiently addressed all of our concerns, but this chaotic orientation process took a few days.
As things settled down, and I began to learn, I was fascinated by my new decision. I knew I had made the right choice. My instructor was a seasoned Medical Assistant, impeccably dressed, with perfect hair, named Jason. I’m a confident heterosexual, and I have no problem with anyone’s orientation, but Jason was a fine looking man. Sometimes I wondered…. he must have had to get up at four in the morning to work on that hair. Perfect hair, always.
By the second week, we were splitting off into small groups. I got to know my classmates more and more, an interesting bunch. We were all older than your classic college students, all coming from careers that had driven us to make a change. There was Fairahn, a demure American Muslim woman who turned out to be smarter than she thought, gaining confidence; there was Teri, a beautiful woman who always looked like she was about to kill someone; there was Jane, who I never quite figured out; there was Joni, a busy mother who struggled at first but turned into one of our best students; there was Janet, a CNA looking to advance, and was a seriously ineffable person, that I still struggle to figure out; and there was Helen, who had a resting bitch-face that could make a honey badger back off.
Wait a minute, I thought. I’m the only male.
I had no problem with that. Perhaps that was just the way the dice rolled. I certainly did not dwell on it; I’ve always believed that women were just as capable of doing any job that a man could do, and vice-versa. The difference is when it comes to reproduction, but vocationally, I’m glad that women are slowly breaking the glass ceiling: the US military, construction, IT, and now a female Vice-President. We would have had a female President in 2016, (I imagine things would be quite different now), except for that Pact with Hell known as the Electoral College. But I digress; I don’t like to talk politics here.
Like I said, it didn’t bother me, at all, that I was the only male student. One day, after class, I asked my instructor about this, and he replied that the field of Medical Assistant is definitely a female-dominated industry.
He wasn’t kidding: https://datausa.io/profile/cip/medical-assistant#demographics
93% of all Medical Assistants in the United States are female.
I have searched all over this unwieldy behemoth known as the internet, and I have asked professionals, as to why this is. There does not seem to be a concrete answer, other than the time-honored tradition of gender stereotyping. Which needs to stop. And in healthcare, it slowly is.
The fact that I was the only male in my class never bothered me at all. I was raised by progressive parents, and, as I mentioned, the glass ceiling needs to shatter.
But it shatters slowly. In the United States, 3.5% of firefighters are female. 39.9% of financial analysts are female. Women make up 9.9% of the construction industry. 19% of software developers are women.
There are dangers to ‘gendered’ jobs: https://www.businessnewsdaily.com/10085-male-female-dominated-jobs.html
When one Googles the question: What is a male nurse called? (this actually happens), the answer comes up: nurse. Among the more conservative elements of our society, labeling a job as ‘female’ can diminish its authority. There are financial dangers as well. Female Medical Assistants, on average, make about 88% of what their male colleagues do, and men are more likely to be promoted. This pay discrepancy is in no way isolated in healthcare; on average, across America, women earn 82 cents for every dollar a man earns: https://blog.dol.gov/2021/03/19/5-facts-about-the-state-of-the-gender-pay-gap#:~:text=1.,for%20many%20women%20of%20color.
But it was never an issue in my class; we all became friends, a team, and the fact that I was male never became an issue. We all had a group text-chat, and kept in close touch when we were out of school. Remember that at-home, online learning? If one of us was stuck, no problem. Text the gang!
I became great friends with the class alpha, Helen. She was the one with the resting bitch face that could stop the blast effect of a nuclear weapon. Our gender differences were never an issue. There was no sexual tension; we were two dedicated students who wanted to do our best. As our school year went on, and we were presented with harder challenges, some quite unexpected, we backed each other up. She was the Furiosa to my Max; two people who found themselves in a difficult situation, and supported each other to get through. Fury Road. Brilliant film. Anyway…
What I have noticed in healthcare is that nearly all of the supportive roles, from CNA up to ARNP, are predominately female. However, with MD’s, the glass ceiling is breaking quickly. I have worked and met many female physicians. Each one capable, each according to their gifts.
My own feeling is this: the gender stereotyping is hard-wired into society’s heads, and has probably been around for a very long time. I know nothing of anthropology, but, at the risk of oversimplifying things, a very long time ago, men were expected to go out and hunt, and protect the tribe, while women were expected to tend to the village and care for the young. This evolution continued into the modern age; where men do the hearty, rough, dangerous things, with unnecessarily large pickup trucks, while women are expected to keep the house and raise the children. But it doesn’t work like that anymore, it can’t. To make ends meet, both partners need to work, and hell, any female can use a firearm, be an astronaut, or a member of Congress. Why, just look at Marjorie Taylor…. Eh. Very poor example.
I have never encountered it, but there can be gender discrimination against males in the Medical Assistant vocation. Many male MA’s are not taken seriously by deeply conservative patients, doctors, and the general public. Men in this role are more often perceived as effeminate or otherwise inadequately masculine (me? No on the former, definitely on the latter). This discrimination could possibly be due to the concept that men are not adequate caretakers. What a load of BS!
https://www.medicalassistantcareerguide.com/gender-discrimination/
On the other hand, many patients can feel more comfortable with a male Medical Assistant, especially male patients. If the patient has a deeply personal problem, they may find it easier to relate to another male.
Though I have experienced no discrimination of my own, and I have never been treated differently because I am a male Medical Assistant, the problem continues in our society at large. Women are just as capable as men, and should be treated not just as equals, but simply fellow human beings. The glass ceiling has many cracks, but our society still has a long way to go.
So I’ll go to work some day, surrounded by estrogen. It doesn’t bother me at all. I’m here to be the best Medical Assistant I can be. If all of my coworkers are female, so be it. As long as you’re cool and can do the job well, preferably the former, you’re okay in my book. I’ve found that it gives me a different perspective, to experience the female side of society. But that is secondary. I need to learn how to find the damn vein for venipuncture, first. And if a female Medical Assistant helps me with a blood draw, I have no problem with that at all.